When the Earth Trembles in the Americas: The Experience of Haiti and Chile 2010

Abstract

The response of the nephrological community to the Haiti and Chile earthquakes which occurred in the first months of 2010 is described. In Haiti, renal support was organized by the Renal Disaster Relief Task Force (RDRTF) of the International Society of Nephrology (ISN) in close collaboration with Médecins Sans Frontières (MSF), and covered both patients with acute kidney injury (AKI) and patients with chronic kidney disease (CKD). The majority of AKI patients (19/27) suffered from crush syndrome and recovered their kidney function. The remaining 8 patients with AKI showed acute-to-chronic renal failure with very low recovery rates. The intervention of the RDRTF-ISN involved 25 volunteers of 9 nationalities, lasted exactly 2 months, and was characterized by major organizational difficulties and problems to create awareness among other rescue teams regarding the availability of dialysis possibilities. Part of the Haitian patients with AKI reached the Dominican Republic (DR) and received their therapy there. The nephrological community in the DR was able to cope with this extra patient load. In both Haiti and the DR, dialysis treatment was able to be prevented in at least 40 patients by screening and adequate fluid administration. Since laboratory facilities were destroyed in Port-au-Prince and were thus lacking during the first weeks of the intervention, the use from the very beginning on of a point-of-care device (i-STAT®) was very efficient for the detection of aberrant kidney function and electrolyte parameters. In Chile, nephrological problems were essentially related to difficulties delivering dialysis treatment to CKD patients, due to the damage to several units. This necessitated the reallocation of patients and the adaptation of their schedules. The problems could be handled by the local nephrologists. These observations illustrate that local and international preparedness might be life-saving if renal problems occur in earthquake circumstances.

Management of Crush Victims in Mass Disasters

“…However, some of these problems may be overcome by logistic planning before disasters as well as by collaboration among disaster-prone countries and with humanitarian organizations during disasters, which may also be helpful for transport across borders. As an example, during the Haiti earthquake in 2010, 43 crush victims were treated in the Dominican Republic because the local Haitian infrastructure was largely destroyed (14). During disasters, chronic dialysis patients may also have problems obtaining dialysis (90).…”

“…This caused loss of manpower and financial resources and at the same time created a risk for health and environment (80,93,96). Therefore, material donations should be limited to what is requested (14,97,98 ) and should be coordinated with teams in the affected area.…”

“…After the Bingol-Turkey earthquake in 2003, early fluid resuscitation was associated with a lower percentage of crush cases requiring dialysis (11) than in other contemporaneous disasters (12,13). Similarly, in the recent Haiti earthquake, dialysis could be avoided in several victims because of intensive fluid administration (14). Therefore, limited dialysis possibilities should not be a reason for abandoning crush victims; with thorough fluid administration, dialysis can often be avoided.…”

The Evolution of Critical Care Nephrology in Edmonton

“…Subsequently, the RDRTF has responded to most of the large earthquakes in developing countries. Dr. Valerie Luyckx, nephrologist at the UAH and Dr. Noel Gibney responded as members of the RDRTF following the catastrophic earthquake in Haiti in 2010 [11,12] . They subsequently contributed to the development of the RDRTF recommendations for the management for crush injury in mass disasters [13] .…”

Early Fluid Resuscitation With Hypertonic Solution in a Rat Crush Injury Model

“…Crush syndrome is common in earthquakes, and recently, numerous patients with CS were reported after 2001 Gujarat earthquake in India (1), 2003 Bam earthquake in Iran (2), 2008 Wenchuan earthquake in China (3), and 2010 earthquake in Haiti and Chile (4). Crush syndrome is the second most frequent cause of mortality after the direct impact of trauma (5,6) and is based on three criteria: involvement of muscle mass, prolonged compression, and compromised local circulation (7).…”